A federal appeals court partially overturned a lower court decision on Friday, reinstating a claim that a Zurich Insurance Group Ltd. entity had not made a timely coverage decision for a healthcare organization.
The Court of Appeal reinstated a claim of unfaithfulness against the insurer.
Macon, Georgia-based Omni Health Solutions LLC, filed an insurance claim with Zurich American Insurance Co. 2011, and sought coverage for a damaged and leaking roof, according to the decision of the 11th U.S. Circuit Court of Appeals in Atlanta Omni Health Solutions, LLC v Zurich American Insurance Co.
Eventually Zurich agreed that covered damage existed, but the parties could not agree on a loss
The parties continued to question the loss that Zurich owed to Omni, despite a multi-year evaluation process that led to binding awards for structural damage and for corporate loss of revenue, t he said.
Omni sued Zurich in state court, which was eventually transferred to the U.S. District Court in Macon. The district court granted Zurich a summary judgment on allegations that it had not made a coverage decision in time, had not paid a full structural assessment and had not paid the reduced value of Omni's property. It also condemned Omni for its unbelief.
A Supreme Court panel of three judges upheld the district court's ruling in Zurich's favor on the charge that it had not paid the full amount of the structural damage and the fee it had not paid for the reduced value of Omni's property.
However, it found that the district court had erred in granting a summary judgment to Zurich regarding its alleged failure to make a timely coverage decision and rejected the allegation of infidelity to which it relates.
"The appellant has the right to make an argument on appeal" which disputes Zurich's characterization of this claim, as well as to assert new arguments, the judgment concludes.
Lawyers in the case did not respond to a request for comment. [1